Kaiser Foundation Hospital in Anaheim, received a “A” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality. (Photo by Mark Rightmire, Orange County Register/SCNG)

Hoag Memorial Hospital Presbyterian in Newport Beach, received a “A” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality. (Photo by Heidi de Marco/Kaiser Health News).

Kaiser Foundation Hospital in Anaheim, received a “A” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality. (Photo by Mark Rightmire, Orange County Register/SCNG)

St. Jude Medical Center in Fullerton, received a “B” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality. (Photo by CINDY YAMANAKA, THE ORANGE COUNTY REGISTER/SCNG)

Mission Hospital Regional Medical Center in Mission Viejo, received a “B” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality. (Photo by NICK AGRO, ORANGE COUNTY REGISTER/SCNG)

St. Joseph Hospital of Orange, received a “B” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality.(File photo by Jebb Harris, Orange County Register/SCNG)

AHMC Anaheim Regional Medical Center received a “D” grade from The Leapfrog Group, an employer-backed nonprofit group focused on health care quality.(Photo by KEN STEINHARDT, Orange County Register/SCNG)

Nearly half of California hospitals received a grade of C or lower for patient safety on a national report card aimed at prodding medical centers to do more to prevent injuries and deaths.

But Orange County hospitals performed better, with only 26 percent scoring a C or worse.

The Leapfrog Group, an employer-backed nonprofit focused on health care quality, issued its latest rating guide last week. The report card is part of an effort to make consumers and employers aware of how their hospitals perform on key quality measures, ranging from medical errors to various types of infections, so that patients can make better-informed health care decisions. The scores are updated twice a year, in spring and fall.

After steady improvement in recent years, California hospitals lost ground in last week’s report card. Two years ago, 37 percent of California hospitals received a C, D or F grade. That increased to 46 percent of the 271 California hospitals rated in the most recent report.

In Orange County, no hospital received an F and only one received a D. The D grade went to AHMC Anaheim Regional Medical Center. In a statement, the hospital expressed disappointment.

“Unfortunately, the recent score includes some older incorrect data going back to 2013 which negatively affected the rating,” the statement said. “We have processes in place to improve patient outcomes and satisfaction. We are confident that quality care and patient safety throughout our hospital will continue to improve.”

The best scores were evenly split in Orange County, with 37 percent receiving an A and 37 percent a B. Four local hospitals were not graded — Orange County Global Medical in Santa Ana, Anaheim Global Medical Center, Chapman Global Medical Center in Orange and South Coast Global Medical Center in Santa Ana. Leapfrog said there was insufficient data to score them.

Many California hospitals still struggle to reduce preventable medical errors and infections in patients, despite industrywide efforts to remedy those problems. California accounted for six of the 10 hospitals nationwide that received an F grade.

California public health officials track an assortment of patient infections that can be acquired during a hospital stay. A recent state report noted progress in some areas, while other issues have been harder to address.

From 2014 to 2015, 56 California hospitals achieved “significant improvement” in preventing certain infections, including ones in the blood and those resulting from surgery, according to the California Department of Public Health. But diarrheal infections in California hospitals have increased 8 percent above a national benchmark since 2011.

The state has created an interactive map where the public can check infection rates by hospital.

Leapfrog, which has issued hospital scores in California and nationwide since 2012, analyzes information it collects as well as data reported to Medicare. Erica Mobley, a Leapfrog spokeswoman, said the group’s methodology compares all hospitals to each other on a national scale, so a mix of factors could be responsible for the lower scores statewide.

“This could represent California hospitals’ performance slipping in comparison to their peers across the country or could also mean that they may be staying constant in their performance while other hospitals are progressing,” Mobley said.

The percentage of hospitals in California that got the top rating also decreased in Leapfrog’s latest analysis. Twenty-five percent of California hospitals, 68 facilities, earned an A grade this year, compared to 43 percent, or 104, in 2015.

California ranked 28th nationally in the percentage of A-rated hospitals.

In Leapfrog’s report card, some performance measures are risk-adjusted for patient severity and income so hospitals aren’t penalized for admitting sicker, poorer patients.

Some hospital industry officials have criticized Leapfrog’s letter grades as too simplistic for a complex issue and as potentially misleading for patients.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, noted there are many different scorecards and said consumers shouldn’t put too much stock in any one ranking.

“While these scorecards often serve as a good starting point for patients to ask questions of their health care provider, they should not be viewed as being a definitive source for determining the quality of care provided by any hospital,” Emerson-Shea said.

The nonprofit Informed Patient Institute advises that patients look at report cards when making an important health decision, such as where to have surgery or deliver a baby. But the group also cautions that it may be difficult to find a complete picture of hospital quality by reviewing report cards that evaluate hospitals in different ways.

Health giant Kaiser Permanente consistently posts some of the highest scores and shows little variation across its 35 hospitals in the state. Thirty-three Kaiser hospitals received A or B grades; two got C grades. The Kaiser hospitals in Anaheim and Irvine scored As.

The University of California health system fared well across seven hospital campuses, with five A ratings and two B grades. UC Irvine Medical Center in Orange received an A.

“It is a privilege to provide our community with the highest level of complex care available in our region,” Dr. Howard Federoff, CEO of the hospital and vice chancellor for health affairs, said in a statement. “Earning a sixth consecutive top rating reflects our entire team’s dedication to patient safety.”

California’s Office of Statewide Health Planning and Development also offers data on hospital quality and patient outcomes. And Medicare posts star ratings for hospitals nationwide, which are another resource for patients and policymakers.

California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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